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ALEXANDRIA, Va. — The National Home Infusion Association (NHIA) applauds the re-introduction of The Preserving Patient Access to Home Infusion Act — bipartisan, bicameral legislation that will ensure Medicare patients can receive the intravenous (IV) medications they need while at home. Introduced in the House by Rep. Vern Buchanan (R-FL), Rep. Diana Harshbarger (R-TN), Rep. Debbie Dingell (D-MI), and Rep. Terri Sewell (D-AL), and in the Senate by Sen. Mark Warner (D-VA) and Sen. Tim Scott (R-SC), the legislation would create a complete home infusion benefit for Medicare patients with serious viral and fungal infections, heart failure, immune diseases, cancer, and other conditions that require the use of an infusion pump.
Home infusion pharmacies have been safely and effectively providing a wide range of IV medications to patients in their homes for over 40 years. This proven model of care is critically important for patients living in rural areas, who are disabled, or have transportation challenges. Additionally, home infusion has shown to be a cost-effective alternative when compared to other sites of care.
First launched in 2019, Medicare’s home infusion therapy (HIT) services benefit has failed to achieve its promise of delivering patient access to home infusion. According to CMS data, several U.S. states haven’t registered a single home infusion service visit. The same report found that less than 1,500 Medicare beneficiaries are receiving home infusion services each calendar quarter — and provider participation in the benefit has steadily declined since implementation.
“Home-based infusion services are a vital component in improving access to life-sustaining IV treatments and enhancing the quality of life for patients and their families, while adding capacity to the health care system,” said NHIA President & CEO Connie Sullivan. “Passage of the Preserving Patient Access to Home Infusion Act will modernize Medicare’s coverage of home infusion, bringing it in line with the commercial sector, and finally achieve Congress’ intent with creating the benefit.”
Congress included provisions in the 21st Century Cures Act and the Bipartisan Budget Act of 2018 to create a professional services benefit for Medicare Part B home infusion drugs. The intent in establishing this benefit was to ensure patient access to home infusion was maintained after Part B drug payments were significantly reduced with the conversion to Average Sales Price methodology. The benefit was intended to provide a per infusion day payment to support all professional services (both remote and in-person) including assessments, education on administration and access device care, clinical monitoring, coordination with the patient, caregivers and other health care providers, and nursing visits.
Despite Congress’ intent, the Centers for Medicare and Medicaid Services (CMS) improperly implemented the benefit by requiring a nurse to be physically present in the patient’s home for providers to be reimbursed. As a practical matter, the current home infusion therapy benefit only acknowledges face-to-face visits from a nurse, failing to account for the extensive clinical and administrative services that are provided remotely by home infusion clinicians. As a result, provider participation in Medicare’s home infusion benefit has been limited and beneficiaries have experienced challenges in accessing home infusion over the last several years.
The Preserving Patient Access to Home Infusion Act provides technical clarifications that will remove the physical presence requirement, ensuring payment regardless of whether a health care professional is present in the patient’s home. The legislation also acknowledges the full scope of professional services and maintains the current reimbursement rate for in-person nursing visits for at least five years. Additionally, the legislation would expand the availability of home infusion to additional patients by making IV anti-infectives available under Medicare’s HIT benefit, a key step in aligning Medicare with commercial market best practices. If implemented, this legislation would enhance patient access to home infusion and increase provider participation in the benefit — effectively diverting care to the home that would otherwise be delivered in more expensive institutional settings.
Learn more about the legislation here.
